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Primary percutaneous coronary intervention in acute ST elevation myocardial infarction: Determinants of outcome

Authors
C Michael Gibson, MS, MD
Joseph P Carrozza, MD
Roger J Laham, MD
Duane S Pinto, MD, MPH
Section Editors
Donald Cutlip, MD
Bernard J Gersh, MB, ChB, DPhil, FRCP, MACC
James Hoekstra, MD
Deputy Editor
Gordon M Saperia, MD, FACC

INTRODUCTION

Patients with symptoms suggestive of an acute myocardial infarction (MI) and having electrocardiographic evidence of an acute MI manifested by ST elevations (>1 mm in two contiguous leads after nitroglycerin to rule out coronary vasospasm) that is considered to represent ischemia are candidates for reperfusion therapy with either primary percutaneous coronary intervention (PPCI) or fibrinolytic therapy. Patients with typical symptoms in the presence of a new or presumably new left bundle branch block or a true posterior MI are also considered eligible. (See "Electrocardiogram in the diagnosis of myocardial ischemia and infarction" and "Electrocardiographic diagnosis of myocardial infarction in the presence of bundle branch block or a paced rhythm".)

Coronary reperfusion with PPCI or fibrinolytic therapy improves outcomes in patients with acute ST elevation MI or an MI with a new or presumably new left bundle branch block or a true posterior MI. If performed in a timely fashion, PPCI is the reperfusion therapy of choice compared to fibrinolysis because it achieves a higher rate of TIMI 3 flow (more than 90 percent) (table 1), does not carry the risk of intracranial hemorrhage, and is associated with improved outcomes. (See 'Prognosis after primary PCI' below.)

The time to onset of reperfusion therapy is a critical determinant of outcome with both PPCI and fibrinolysis [1]. (See "Fibrinolysis for acute ST elevation myocardial infarction: Initiation of therapy", section on 'Initiation of therapy'.)

This topic will discuss the impact of the following factors on outcomes in patients who undergo PPCI:

The time between symptom onset and PCI, also referred to as treatment delay (See 'Time from symptom onset' below and 'Definitions' below.)

                       

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Literature review current through: Nov 2016. | This topic last updated: Wed Apr 06 00:00:00 GMT+00:00 2016.
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